Healthcare Provider Details

I. General information

NPI: 1639359813
Provider Name (Legal Business Name): MICHAEL KENJI YAMAZAKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S KING ST BONE AND JOINT CENTER
HONOLULU HI
96813-3097
US

IV. Provider business mailing address

888 S KING ST BONE AND JOINT CENTER
HONOLULU HI
96813-3097
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-2639
  • Fax: 808-522-4401
Mailing address:
  • Phone: 808-522-2639
  • Fax: 808-522-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA101393
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number15519
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: